Ballot on NHS poses a dentist's dilemma: The profession feels it is being penalised for working harder and attracting patients. Liz Hunt reports

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The Independent Online
HATIM KAPADIA is one of two dentists running a practice in Archway, north London. Today, he and his partner face much 'soul-searching and a moral dilemma' as they consider the result of the British Dental Association ballot, and decide whether or not to follow the advice of the association to stop accepting new patients of any age for National Health Service dental treatment. Financially, they do not have much choice, he said.

The high street practice is 40 years old, founded just four years after the introduction of the National Health Service in 1948, a fact that Mr Kapadia is acutely conscious of.

He agrees with those who predict that NHS dentistry is on the verge of collapse, and accuses the Government of 'subtle attempts' to privatise it.

What exactly he will say to his patients - those already registered and those he may have to turn away - is also foremost in his mind. 'It will be very difficult to justify such a decision to them, but it is a question of me remaining in practice and treating the patients I have or going under.'

Mr Kapadia is a member of the BDA and he voted with the majority of other members in the ballot on the three questions posed by the association: are you prepared to remove adult patients from your list (45 per cent for, 55 per cent against); are you prepared not to accept new patients of any age (58 per cent for, 42 per cent against); are you prepared not to accept charge-paying adult patients (80 per cent for, 20 per cent against).

The ballot was called after the Government imposed a 7 per cent cut in fees - effective from tomorrow - to ensure that the Department of Health remains within budget.

It had calculated for 22 million patient registrations in 1991, when the actual figure was 26 million, forcing the Department of Health to pay out pounds 200m more to dentists than it expected. For working harder and attracting more patients, the dentists are being penalised, Mr Kapadia said.

Despite his vote, Mr Kapadia has not yet made a final decision. 'Now I've got to talk to my colleagues and sound them out about how they feel. I'm more inclined to go with the ballot. I feel that I will be at a great disadvantage if I don't and there is a threat to my livelihood.'

Dentists in high-cost areas, with high rents and overheads, are particularly at risk because of the fee cut, he said. 'I would have to consider cost-cutting, reducing staff, not replacing new equipment and perhaps not decorating the practice. You cannot jeopardise patient care.'

He predicted a sea change in the way dentistry is practised in Britain - a much tougher and harsher environment - as more dentists left the NHS, insisted on 'up front' payments, and introduced charges for cancellations. 'We are going backwards instead of progressing,' he said. 'The ballot reflects the extent of the profession's disenchantment.'